Provider Demographics
NPI:1366535023
Name:CENIKOR FOUNDATION
Entity type:Organization
Organization Name:CENIKOR FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-266-9944
Mailing Address - Street 1:PO BOX 4785
Mailing Address - Street 2:MSC 675
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210
Mailing Address - Country:US
Mailing Address - Phone:713-266-9944
Mailing Address - Fax:713-780-3191
Practice Address - Street 1:3416 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708
Practice Address - Country:US
Practice Address - Phone:254-224-8880
Practice Address - Fax:254-756-2145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENIKOR FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X
TX316-3542251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0655219-01Medicaid